How much training is required to implant and manage CRT?

The number of patients receiving cardiac resynchronization therapies (CRTs) is increasing at a substantial rate. The implant, however, is not always performed effectively and the complication rates are considerable. The training and accreditation to perform CRT need to be evaluated to optimize procedural and patient outcomes.

The relationship between higher procedural volumes and reduced procedural complications is evident and consistent across a range of surgical specialties and procedures. Present guidelines recommend that training in CRT can be achieved with five to 25 cases. The limited studies in this area suggest that this is inadequate, with complication rates of CRT reducing significantly with procedural experience well beyond 100 cases.There is increasing evidence that the development of procedural skills is dependent not only on cognitive factors, but also on a number of intrinsic visuospatial factors and fine motor dexterity. These factors can be tested objectively and the validity of adopting these techniques for the selection and training of operators is being evaluated.

Ongoing evaluation of the training requirements and accreditation is required to optimize the implantation of CRT.